Immuno-oncology at ECIO 2023

June 7, 2023

The landscape of cancer care has changed drastically over the past twenty years. Interventional oncologists are well aware of this, having themselves seen the evolution of interventional oncology (IO) from a little-known, often palliative discipline to a dynamic and expanding field with first-line and curative treatment options.

As IOs continue the push to ensure interventional oncology’s place as the fourth pillar of cancer care, the emergence of immuno-oncology and its intersection with IO carry exciting possibilities for the future.

Immuno-oncology is one of the most innovative areas of cancer research – it seeks to use a patient’s own immune system to fight cancer by means of antibodies and antigens used to stimulate the immune system. A still-new tool in the oncology arsenal, immuno-oncology has gained a great deal of research momentum over the past five years, a trend that is expected to continue.

IO could be combined with immunotherapy with the possible goals of increasing the responsiveness of tumours to immunotherapy, or to provide a means for delivering immuno-agents to tumours. The promising benefits and current challenges of combining these two fields were a hot topic at ECIO 2023 – and we are sure to see more on this in the future.

Immuno-oncology for IOs: current knowledge

Moderators D. Arnold and M. Ahmed led participants through this well-attended session on the second day of ECIO 2023.

Moderators D. Arnold and M. Ahmed

R. Duran presenting

C. Ottensmeir began the session by giving an overview on the borderline between success and failure in immune tumour responsiveness. “Immunotherapy is still the new kid on the block, but maybe we should call it the new adolescent by now” he began, referring to the fact that, while immunotherapy is new, it has become a standard treatment with marked clinical benefits in responders. “It’s really changed the way we think about cancer treatment in a relatively short interval.”

Medical oncologist A. Digklia then spoke on biomarkers – biological molecules found in blood or tissue that can be a sign of disease used to see how well the body responds to treatment. Biomarkers could allow for the selection of patients that will best respond to therapy and suggest individualized therapy regimens. She gave a technical overview of biomarkers currently approved by US and EU authorities for the use of checkpoint inhibitors, including how biomarkers can indicate treatment success.

R. Duran took the stage to speak on how to best stimulate the immune system with ablative treatments. He spoke first on tumour ablation, a technique which has developed exponentially in only a few decades, before moving on to the question of if heat or cold is more immunogenic when applied in an ablative technique.  Cold techniques, e.g. cryoablation, could be a better source of antigens in comparison to hyperthermic techniques (HIFU, RFA, MWA).

He also spoke on more recent ablative methods, IRE and histotripsy, which, while lacking in data, do show promising preliminary results in their ability to preserve immunogenicity. “Ablative therapies are immunogenic. Which one is the best? To be honest, at this stage, we don’t know. Some seem better than others, but more data is needed.” What we do know is that ablation alone is unlikely to cause system-wide, sustained tumour regression. Therefore, ablation – Duran  concluded – should always be combined with immunotherapies.

A. Digklia answers a question during the discussion portion of the session

D. Madoff then spoke on the rational and clinical results on intraarterial therapies for priming the immune system. He spoke on the more-extensive-than-expected history and efficacy of transarterial immunoembolization before moving on to explain the specific immune changes induced by intra-arterial therapies. “It’s really critical to understand these mechanisms when planning to combine locoregional therapies with immunotherapy in clinical trials.” He stated. “In our lab, for example, we have shown recently that just by changing the embolic agent that you can really impact the immune response; that then may have a confounding variable which then may change the results.” He ended his presentation by echoing the sentiment of other presenters that further research and more data are vital.

L. Tselikas was the final presenter in this session, speaking on the place of IO in oligoprogression and oligoresistance. After defining oligoprogression (all tumours respond, but a few reoccur) and oligoresistance (mixed tumour response), he went on to discuss the advantages and limitations of IO for oligoprogression based on the available data. Of note, oligoprogression patients do have longer survivals under immunotherapy – so is there an added value in combining it with IO? “Actually, we don’t really know.” – but theoretically, IO may help immunotherapy in overcoming oligoresistance and could help control in cases of oligoprogression. “We’re lacking in clinical evidence, but it’s coming. We need to use biomarkers, and if possible, the ones that you can use in clinics for every patient.”

J. Ricke presents during the meet the PI session

L. Tselikas presents on the HOLMBRAVE study

Meet the PI

The increasing importance of immuno-oncology could also be seen in the upcoming research discussed at ECIO – several of the studies discussed in this year’s “Meet the PI: upcoming research” session included a focus on immune-oncology.

J. Ricke presented on his upcoming trial, “Zugspitze: SIRT and PD-L1/CTLA-4 inhibition in BCLC B.” This open-source concept three-arm study, which he hopes will be initiated in the next weeks, will look at SIRT plus immunotherapy in patients with unresectable HCC: BCLC B and Child-Pugh A.

L. Tselikas presented once more, this time in his capacity as the primary investigator on the HOLMBRAVE study, which will look at immunotherapy and holmium SIRT in combination for advanced HCC. Five French-speaking centres are involved in this multicentre phase II study, which is already open and enrolling patients.

Poster awards

This year’s Magna Cum Laude poster award winner, A. Mikhail, also focused on immunotherapy with his poster, “PD-L1 checkpoint inhibitor-eluting radiopaque “immuno-beads” for “immuno-embolization” in woodchuck hepatocellular carcinoma.”

View the poster below,  or read our short interview with the winner here!

Further reading: